tbuckley/cabot-search huggingface dataset:
Abstract 07: Percutaneous Ventricular Assist Devices In Refractory Cardiac Arrest: The Role Of Chest Compressions
Authors: Adam L Gottula, Brendan McCracken, Takahiro Nakashima, Nicholas Greer, Traci Cramer, Nadia R Sutton, Kevin R Ward, Robert H Neumar, Cindy H Hsu, Mohamad H Tiba
Journal: Circulation (2022)

Background: Recent studies describe an emerging role for percutaneous ventricular assist devices (pVADs, Impella CP®, Abiomed) as rescue therapy for refractory cardiac arrest (CA). We hypothesized that continuing mechanical chest compressions (mCPR) after initiation of pVAD would improve hemodynamics by decompressing the right ventricle and augmenting pulmonary blood flow and left ventricular filling. We performed a pilot study to test this hypothesis using a swine model of prolonged cardiac arrest. Methods: Eight Yorkshire swine, anesthetized, intubated and instrumented for hemodynamic monitoring, were subjected to untreated ventricular fibrillation for 5.75 (SD 2.90) minutes followed by mCPR for a mean of 20.00 (SD 5.0) minutes before initiation of pVAD (Table 1). After pVAD initiation mCPR was stopped (n=4) or continued (n=4). Defibrillation was attempted 4, 8 and 12 minutes after initiating pVAD circulatory support, except for the first pilot animal where it was attempted at 2 minutes. The animals that achieved return of spontaneous heartbeat&amp;nbsp;(ROSHB) were maintained on pVAD support for four additional hours. Results: There was no difference in the rate of ROSHB between groups (Table 1). The pVAD + mCPR group had significantly higher pVAD flow prior to ROSHB at four- and twelve-minutes after pVAD initiation, and significantly higher end tidal CO 2 (PetCO 2 ) at four- and eight-minutes after pVAD initiation, when compared with the pVAD alone group (Table 1). There was a trend toward higher carotid artery flow prior to ROSHB in the pVAD + mCPR group compared with the pVAD alone group after pVAD initiation, but the difference&amp;nbsp;was not statistically significant (Table 1). Conclusion: The addition of mCPR to pVAD support during cardiac arrest may generate higher pVAD flow and cardiac output prior to ROSHB compared to pVAD alone. Further studies are needed to determine if this approach improves other hemodynamic parameters or outcomes after prolonged cardiac arrest.
Abstract 10130: Relationship Between Perceived and Measured Diet Quality Improvements in a Randomized Weight Loss Trial
Authors: Jessica Cheng, Tina Costacou, Susan M Sereika, Bonny Rockettewagner, Andrea M Kriska, Mary Lou Klem, Margaret B Conroy, Bambang Parmanto, Lora E Burke
Journal: Circulation (2022)

Background: Cross-sectional evidence suggests individuals overestimate their consumption of healthful foods. However, how perceived diet quality (PDQ) relates to diet quality calculated from standard methods is unclear. Examining study participants' misperceptions of either diet quality, and/or improvements in diet quality, may enhance our understanding of factors that influence the effectiveness of dietary interventions. Methods: The Healthy Eating Index (HEI-2015) was calculated pre- and post-intervention from dietary recalls in this randomized weight loss trial. Participant self-perception of pre-intervention and post-intervention diet quality was rated on a scale of 0 to 100 at the 12-month post-intervention time point. Agreement between perceived and calculated diet quality was examined using Bland-Altman method. Good agreement between measures was considered scores within 6 points. Results: Participants with complete HEI and PDQ data (n=116) was similar to the total sample and mostly female (79%), white (84%), and with median (q1, q3) age of 51.5 (35.5, 58.5) years. A quarter of participants had good agreement between HEI and PDQ scores at 12 months with differences between scores ranging from -44.8 to 29.9 points. Most of the disagreement arose from PDQ scores being higher (mean [std] 67.6 [18.5]) than HEI scores (mean [std] 56.4 [13.6]). Only 12% of participants had good agreement between change in HEI and change in PDQ scores with differences ranging from -68.4 to 39.6 points. Again, disagreement mainly arose from higher perceived improvement in diet quality (mean=18.6 points) compared to improvement in HEI scores (mean=1.3 points). Discussion: The diet quality of weight loss-seeking adults is less than ideal with little evidence of improvement; however, the majority of participants appear to perceive their diet quality and improvements in diet quality as better than measured. Future studies might consider the effect of better aligning participants’ perceptions with reality.
Abstract 10144: New Cardiovascular Events After Covid 19 Infection
Authors: Pierantonio Russo, Ramaa Nathan, Michael Sicilia, Anirvan Gosh
Journal: Circulation (2022)

Introduction: The incidence and persistence of cardiovascular events (CVES) occurring for the first time following COVID-19 is not completely established. Hypothesis: After COVID-19 there is an increased risk of new CVES that may persist several months after the acute infection. Methods: A retrospective claims analysis using the Symphony Health IDV, healthcare database of administrative medical and pharmacy claims for ~ 280 million lives in the USA. Patients with a claim for COVID-19 between April and June 2020 were identified and a sub cohort with new claims for CVES up to 12 months post COVID-19 was analyzed. Patients with prior history of CVES were excluded Results: 17,360 patients without prior history of CVES, age range 18-80 year (average: 55; SD: 16), 46% males and 54% females, experienced various CVES for the first-time post COVID-19. Specifically, a sub-cohort of 6,545 (38%) hospitalized patients experienced congestive heart failure (CHF) (18% ); myocardial infarction (MI) (36% ); stroke (54%);Arrythmias (54%); pulmonary embolism (15%) and peripheral arterial thrombosis (1%). Cardiomyopathy/myocarditis was reported in 253 patients. Of the new events, 25% of acute CHF, 46% of acute MI and 31% of acute stroke occurred within 28 days of hospitalization for COVID-19. The hazard of CVES peaked within 1 month from the onset of the infection and persisted up to 12 months after hospitalization. Highest residual risk factors were CHF, pericarditis, and myocarditis. Machine Learning analysis identified hypertension and COPD as strong predictors of new CVES post Covid-19. Conclusions: The occurrence of new CVES in survivors of COVID-19 is substantial. A deeper understanding of the biologic mechanisms triggering new cardiovascular disease after COVID-19 infection is needed to design interventions directed at preventing the incidence and persistence of new CVES post COVID-19 infection.
Abstract 10779: Lower Socioeconomic Status, Psychological Distress, and Hypertension: A Longitudinal Moderated Mediation Analysis
Authors: LiYing Zhang, Rhonda Dailey, Robert D Brook, Ijeoma N Opara, Xianchen Liu, Jason T Carbone, Phillip Levy
Journal: Circulation (2022)

Introduction: Lower socioeconomic status (SES) has been associated with hypertension (HTN); however, the mediators and moderators of this association remain understudied. We used longitudinal data to examine the mediating effect of psychological distress on the link between lower SES and HTN, as well as the racial and sex moderation effects. Methods: This study was a secondary analysis of data collected from 2009 to 2019 among adults with six-wave biennial surveys from the Panel Study of Income Dynamics (PSID). SES was assessed with individuals’ education, employment status, and income. The Kessler K6 scale was used to assess psychological distress. HTN was a self-reported physician-diagnose. Data of families’ head who did not have HTN in 2009 were analyzed. Sequential mediation and moderated mediation models were performed using the PROCESS macro in SPSS. Results: The mean age of the sample in 2009 was 45 years (33% female). The prevalence of HTN increased significantly from 31% in 2009 to 41% in 2019. Participants who had no HTN with lower SES in 2009 were more likely to develop HTN in 2019 (OR=1.11, 95% CI: 1.03-1.20, p &lt;0.01). Sequential mediation analysis showed that psychological distress was a significant mediator of the association between lower SES and HTN (indirect effect=0.02, p &lt;0.05) and the mediation effect was moderated by sex but not by race. Females with lower SES were at a higher risk (index of moderated mediation=0.01, p &lt;0.05). Conclusions: Lower SES was longitudinally associated with increased risk of HTN 10 years later. The link of lower SES and HTN was mediated by psychological distress and sex moderated the mediation effect. Sex-tailored interventions of psychological distress should be considered to reduce risk of HTN in lower SES individuals.
Abstract 10781: An Unusual Case of Transient Inflammatory Constrictive Pericarditis: IgG4 Disease
Authors: Muhammad Majid, Hassan Mehmood Lak, Zachary S Yaker, Samia H Mazumder, Ankit Agrawal, Alveena Syed, Allan L Klein
Journal: Circulation (2022)

Case Presentation: A 54-year-old male with a past medical history of hypertension presented with chest tightness, shortness of breath, fatigue, and ankle edema. His vital signs were within normal limits but physical exam was significant for jugular venous distension and bilateral peripheral edema. Laboratory studies were unremarkable except for elevated inflammatory markers (C-reactive protein [23.6 mg/dl] and erythrocyte sedimentation rate [34 mm/hour]). Interferon assay, Influenza A/B antigens and anti-nuclear antibody were negative. The patient was diagnosed with constrictive pericarditis (CP). Although the patient was treated appropriately for pericarditis with a steroid taper, colchicine and ibuprofen, his symptoms recurred. Therefore, he underwent a radical pericardiectomy which resulted in a marked clinical improvement. The final pericardial pathology revealed fibrosis and plasma cell infiltrates with &gt;30% of cells positive for IgG4. An echocardiogram revealed a small pericardial effusion with septal bounce, annulus reversus, and a plethoric inferior vena cava consistent with a diagnosis of CP. Cardiac magnetic resonance imaging showed a small circumferential pericardial effusion and respirophasic septal flattening during inspiration with marked pericardial delayed enhancement (DHE). Discussion: CP is commonly caused by viral or idiopathic etiologies, with infection (tuberculosis) being more prominent in developing countries. IgG4 disease is an uncommon cause of CP with only a few cases of IgG4-related CP have been reported. Pathological findings on histology include IgG4-positive lymphoplasmacytic cells and fibrosis. The disease is characterized by steroid-responsive condition but pericardiectomy is pursued with a suboptimal response. Cardiovascular manifestations of IgG4 disease are under explored and our case illustrates the importance of recognizing and treating the pericardial complications of IgG4 disease.
Abstract 10861: Temporal Trends in Cardiovascular Disease Among Asian American Subgroups
Authors: Kaylin T Nguyen, Jiang Li, Allison Peng, Paul A Heidenreich, Latha Palaniappan, Celina M Yong
Journal: Circulation (2022)

Introduction: Asians represent the fastest growing race/ethnic group in the U.S. Yet there is limited data differentiating the prevalence of cardiovascular disease among diverse Asian and mixed-race subgroups. Methods: Patients receiving care from a mixed-payer health care organization in Northern California between 2007-2018 were classified into self-identified race/ethnic subgroups. Cardiovascular disease diagnoses were identified from ICD-9 and ICD-10 codes. Cardiovascular disease prevalence over time was compared for each racial subgroup to Non-Hispanic White (NHW) with logistic regression models, which evaluated the interaction between race and year (continuous variable), controlling for age and gender. Results: Among 3,494,071 patient-years (56% female, mean age 49 years + 17), prevalence of cardiovascular disease increased faster among all Asian subgroups, except Japanese and Native Hawaiian/Pacific Islander, compared to NHW (adjusted, p&lt;0.01 for each) ( Figure ). Among all subgroups, Filipinos had the highest overall cardiovascular disease prevalence, which increased from 32.2% to 45.1% over the study period (reference: increase from 16.5% to 21.9% among NHW, p=.002). Among subcategories of disease, the prevalence of hypertension increased faster compared to NHW in every subgroup other than Japanese (Native Hawaiian/Pacific Islander p=0.045, p&lt;0.01 for other subgroups). Coronary artery disease prevalence also increased faster among Asian Indian, Chinese, Filipino subgroups compared to NHW (p&lt;0.0001 for each). However, myocardial infarction prevalence increased slower in Chinese and Korean subgroups compared to NHW (p=0.045 and p=0.02, respectively). Conclusion: Analysis of disaggregated Asian subgroups and mixed-race groups demonstrate the diversity of evolving cardiovascular disease prevalence over time, suggesting the importance of tailored approaches to reducing cardiovascular disease among racial subgroups.
Abstract 10103: Polygenic Scores and Longitudinal Trajectories of Cardiometabolic Phenotypes
Authors: Simon S Braendle, Natalie Hasbani, Alanna C Morrison, Klodian Dhana, Paul De Vries
Journal: Circulation (2022)

Introduction: Genetic predisposition via polygenic scores (PGS) is strongly associated with single measurements of systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C), but it is unclear how PGS are associated with their longitudinal trajectories and how these trajectories are associated with risk of coronary heart disease (CHD). Hypothesis: PGS are associated with classes of longitudinal trajectories, and these trajectories are associated with CHD. Methods: Analyses were conducted in 8,453 white participants from the Atherosclerosis Risk in Communities study. SBP and LDL-C measurements were adjusted for medication use. Latent class models were used to group participants into longitudinal trajectory classes based on SBP and LDL-C values from 3-5 visits over up to 27 years. PGS were created by multiplying publicly available weights with participant genotype dosages. The association between PGS and trajectory classes for SBP and LDL-C was examined using logistic regression. We then examined the association of trajectory classes with incident myocardial infarction (MI) and CHD using cox proportional hazard models. Results: Participants were assigned to 4 classes of SBP and 2 classes of LDL-C trajectories ( Figure ). The SBP PGS was significantly associated with SBP classes 2 (OR = 1.28 per standard deviation change in the PGS, P = 4.8E-7) and 4 (OR = 1.7, P &lt; 2E-16) relative to class 3, and with class 4 relative to class 2 (OR= 1.3, P = 2.0E-6). The LDL-C PGS was significantly associated with class 2 (OR = 1.63, P &lt; 2E-16). There were 147 CHD and 102 MI events during 7 additional years of follow up. SBP class 2 and LDL-C class 2 were significantly associated with greater risk of incident MI. Conclusions: Our results highlight longitudinal trajectory classes as a tool for contextualizing the genomics of cardiometabolic phenotypes and the association of these phenotypes with CHD.
Abstract 10095: Association of Plasma Adiponectin and Leptin Levels With All-Cause Mortality and New-Onset Ventricular Tachyarrhythmias in Patients With Hypertrophic Cardiomyopathy
Authors: Keitaro Akita, Lusha W Liang, Kohei Hasegawa, Michael A Fifer, Mathew S Maurer, Muredach P Reilly, Yuichi J Shimada
Journal: Circulation (2022)

Introduction: Hypertrophic cardiomyopathy (HCM) is one of the leading causes of sudden cardiac death in the young. The current models to predict ventricular tachycardia/fibrillation (VT/VF) and mortality perform poorly. Adipokines are secreted from the adipose tissue and regulate cardiac inflammation, fibrosis, and hypertrophy. Among the adipokines, adiponectin and leptin are related to cardiac remodeling in HCM. The present study examined the association of plasma adiponectin and leptin levels with all-cause mortality and VT/VF in patients with HCM. Hypothesis: Plasma adiponectin and leptin levels at enrollment are associated with all-cause mortality and VT/VF in patients with HCM. Methods: We performed a multicenter prospective cohort study of patients with HCM. We measured plasma adiponectin and leptin levels at enrollment. The outcome was a composite of all-cause mortality and new-onset VT/VF. After dividing the cohort into four groups according to the adiponectin and leptin levels, we compared the risk of the outcome event using the Cox proportional hazards model adjusting for age, body mass index, left atrium diameter, and maximum left ventricular wall thickness, using the largest group as a reference. Results: During a median follow-up of 3.3 years, the outcome event occurred in 37 out of 402 patients. The four groups divided by adiponectin and leptin levels had different risks of the outcome event (log-rank P &lt;0.001). The Cox proportional hazards model revealed that the High-Adiponectin, Low-Leptin group had a significantly higher risk (adjusted HR 5.02, 95% CI 1.63-15.47, P =0.005. Figure ) compared with the reference (Low-Adiponectin, High-Leptin) group. Conclusions: The combination of high plasma adiponectin and low leptin levels is independently associated with mortality and new-onset VT/VF in patients with HCM. These adipokines have a potential to become novel biomarkers for risk stratification in HCM to improve the current prediction models.
Abstract 10039: Cardiomyocyte N-myristoylation Plays an Essential Role During the Development of Heart Failure
Authors: Yusuke Tomita, Tomofumi Misaka, Fumiya Anzai, Shohei Ichimura, Kento Wada, Yusuke Kimishima, Yasuchika Takeishi
Journal: Circulation (2022)

Background: N-myristoylation is co- and post-translational modifications of proteins, which involve attachment of myristic acid to the N-terminal glycine. Although N-myristoylation plays important roles in physiological activities such as intracellular signaling, the precise regulation and functional relevance of N-myristoylation in the heart remain to be elucidated. Methods and Results: We applied a click chemistry-based approach to determine the global N-myristoylated protein profiling in the cardiomyocyte. Proteomics analysis identified 41 and 34 N-myristoylated proteins in H9c2 myocytes and neonatal rat cardiomyocytes, and 66.1% of them were discovered for the first time at endogenous levels. The levels of N-myristoylation were significantly decreased by the N-myristoyltransferase (NMT) 2 inhibition with siRNA or adenoviral shRNA knockdown, but not by the NMT1 inhibition. In response to angiotensin II (AII), N-myristoylated levels were differentially altered, and MARCKS was identified as the most down-regulated N-myristoylated protein. Wild-type MARCKS was localized to the cellular membrane, while the mutant MARKS with replacement of N-terminal glycine to alanine (G2A), which lacked the capacity of N-myristoylation, exhibited cytosolic distribution. Cardiomyocyte hypertrophy was exacerbated in mutant G2A MARCKS accompanied by increased levels of histone acetylation and phosphorylation of HDAC4 and CaMKII after AII. Gene transfer delivering NMT2 gene specific to the heart using adeno-associated virus 9 significantly improved pressure overload-induced left ventricular systolic dysfunction, cardiac hypertrophy, and myocardial fibrosis, associated with decreased levels of histone acetylation after the transverse aortic constriction in mice ( Fig ). Conclusion: Cardiomyocyte N-myristoylation plays an essential role in developing heart failure, and its modification by NMT2 may be a novel therapeutic strategy for heart failure.
Abstract 10054: Super Resolution Deep Learning Reconstruction for Detection of In-Stent Restenosis
Authors: Hideki Kawai, Sadako Motoyama, Masayoshi Sarai, Yoshihiro Sato, Hiroshi Takahashi, Takashi Muramatsu, Jagat Narula, Hideo Izawa
Journal: Circulation (2022)

Introduction: Evaluation of in-stent-restenosis (ISR), especially of small stents, remains a challenge for computed tomography (CT) angiography. Hypothesis: To quantitatively define stent strut thickness and lumen vessel diameter at the stent site by deep learning reconstruction and compare this with conventional reconstruction strategies. Methods: We employed ultra-high-resolution CT (URCT) data to train a super resolution neural network (Precise IQ engine, or PIQE) and apply the network to current standard resolution CT (Forward projected model-based Iterative Reconstruction SoluTion, FIRST). We examined 166 stents in 85 consecutive patients who underwent CT and invasive coronary angiography (ICA) within three months of each other from 2019-2021 after percutaneous coronary intervention with coronary stent placement. The diagnostic accuracy for the presence of ISR was defined as percent diameter stenosis &gt; 50% on ICA. All images were reconstructed with PIQE and FIRST and assessed by two blinded cardiovascular imagers. Results: Compared to FIRST, the full width at half maximum of the lumen was larger, and that of the strut was smaller in PIQE. Image quality score was significantly better in PIQE than in FIRST (4.2±1.1 vs. 2.7±1.2, P &lt;0.01). The sensitivity, specificity, PPV, NPV, and accuracy for detection of ISR in PIQE were better than the FIRST (86.1, 89.5, 50.0, 98.1, and 89.2 vs. 80.6, 77.4, 30.2, 97.0, and 77.7, respectively); the differences were particularly pronounced in a group with &lt; 3.0 mm stent diameter. Conclusions: PIQE provides superior image quality and diagnostic accuracy for ISR, even in stents with &lt; 3.0 mm diameter.
Abstract 10683: Alternations in Autonomic Function During Pulmonary Vein Isolation Without Targeting Ganglionated Plexi Ablation in Patients With Atrial Fibrillation
Authors: Takuto Hamaoka, Jonathan C Luck, Mario Gonzalez, Jian Cui
Journal: Circulation (2022)

Introduction: Abnormal autonomic innervation in the left atrium was reported to be related to developing/sustaining atrial fibrillation (AF). Autonomic denervation by radiofrequency catheter ablation (RFCA), evaluated by heart rate variability (HRV), is associated with a lower recurrence rate of AF. Ganglionated Plexi (GP) has been regarded as a target of autonomic denervation during the RFCA; however, the degree by which autonomic function is altered during the RFCA procedure remains unclear. Hypothesis:We tested the hypothesis that autonomic function is altered consistently during the ablation procedure without targeting GP. Method: Thirteen patients with paroxysmal AF who underwent pulmonary vein isolation (PVI) via RFCA were included (Age, 64.3 ± 1.9; Male/Female, 10/3). PVI was performed in the order prescribed (left superior, left inferior, right superior, and right inferior PV). HRV was assessed prior to, during each PV ablation, and post-ablation. Results: A vagal response (significant bradycardia) during the procedure was observed in three patients. The parameter of para-sympathetic nerve activity (para-SNA) (e.g., RMSSD, 38.7 ± 7.8 vs. 26.6 ± 6.0 ms, P &lt; 0.05), and total power of HRV (1861 ± 831 vs. 1105 ± 584 ms, P &lt; 0.05) were decreased by the procedure. While the balance of SNA to para-SNA (ratio of low to high frequency, LF/HF) was unchanged, which may indicate both SNA and para-SNA denervation. Using a linear mixed effect model, the effect of the “period” (i.e., pre, each PV, post) on the reduction in para-SNA parameter (HF) or total power of HRV was significant (both, P &lt; 0.05). The reduction was consistent in each PV, and post-hoc analysis (Bonferroni) showed significant differences only between baseline and post-RFCA in these parameters (P &lt; 0.05). Even in the patients without significant bradycardia response, the reduction in HRV parameter was significant in the linear mixed effect model (e.g., the effect of the “period” on RMSSD, P &lt; 0.05). Conclusion: We found that the PVI by RFA, without targeting GP, modified autonomic function, even in the patients who did not develop vagal responses. The HRV change was consistent during each PV isolation, which may suggest the non-necessity of GP ablation for autonomic modification by the ablation.